The sensitivity of qSOFA calculated at triage and during emergency department treatment to rapidly identify sepsis patients

Abstract

The quick sequential organ failure assessment (qSOFA) score has been proposed as a means to rapidly identify adult patients with suspected infection, in pre-hospital, Emergency Department (ED), or general hospital ward locations, who are in a high-risk category with increased likelihood of “poor outcomes:” a greater than 10% chance of dying or an increased likelihood of spending 3 or more days in the ICU. This score is intended to replace the use of systemic inflammatory response syndrome (SIRS) criteria as a screening tool; however, its role in ED screening and identification has yet to be fully elucidated. In this retrospective observational study, we explored the performance of triage qSOFA (tqSOFA), maximum qSOFA, and first initial serum lactate (> 3 mmol/L) at predicting in-hospital mortality and compared these results to those for the initial SIRS criteria obtained in triage. A total of 2859 sepsis cases were included and the in-hospital mortality rate was 14.4%. The sensitivity of tqSOFA ≥ 2 and maximum qSOFA ≥ 2 to predict in-hospital mortality were 33% and 69%, respectively. For comparison, the triage SIRS criteria and the initial lactate > 3 mmol/L had sensitivities of 82% and 65%, respectively. These results demonstrate that in a large ED sepsis database the earliest measurement of end organ impairment, tqSOFA, performed poorly at identifying patients at increased risk of mortality and maximum qSOFA did not significantly outperform initial serum lactate levels.

Comparison of different versions of the quick sequential organ failure assessment for predicting in-hospital mortality of sepsis patients: A retrospective observational study

“…Our result is consistent with recent studies that emphasized the poor performance of qSOFA in the prediction of sepsis mortality. [16,17] A retrospective study by Moskowitz et al [18] found that the qSOFA had a sensitivity and specificity of 39% and 87%, respectively, when used in predicting in-hospital mortality at the time of ED presentation among 24,164 patients with sepsis.…”

Development and validation of a comprehensive early risk prediction model for patients with undifferentiated acute chest pain

“…Existing scores and rapid troponin pathways do not provide information regarding the risk of a non-coronary diagnosis being present, which partially limits their utility in facilitating early discharge. Several pre-hospital scores (such as NEWS, MEWS, PMEWS) are aimed at determining critically unwell patients for transport to hospital, but the focus of these has been to identify patients at risk of imminent deterioration rather than patients that need further investigation or are safe for early discharge [20] , [21] , [22] , [23] . To our knowledge, the ECAMM risk score model is the first clinical risk score addressing this need, and discriminatory performance for the composite outcome, and its individual components, was substantially higher in comparison to the HEAR and EDACS scores.…”

Sepsis of Patients Infected by SARS-CoV-2: Real-World Experience From the International HOPE-COVID-19-Registry and Validation of HOPE Sepsis Score

“…On the other hand, the specificity and PPV of the HOPE Sepsis Score to predict the risk of sepsis were lower in patients with intermediate than those with high-risk for sepsis, respectively (specificity: 80.3 vs. 99.2% and PPV: 32.4 vs. 66.1%). However, the sensitivity and specificity of qSOFA ≥ 2 to predict in-hospital mortality were 69 and 55.5%, respectively (21). In 2,112 patients suffering from infections, the calculation of systemic inflammatory response syndrome (SIRS) and qSOFA showed a sensitivity of 52.8 and 19.5% and a specificity of 52.5 and 92.6% for 28-day mortality (22).…”